Lisfranc injuries have been rising in incidence and can cause significant and lasting morbidity. There is no consensus on the optimal surgical treatment for these injuries, be they primarily ligamentous or combined (bony and ligamentous). No study has ever followed Lisfranc injury patients postoperatively using advanced imaging. The purpose of this study was to compare the functional and radiographic outcomes of primarily ligamentous and combined osseous and ligamentous Lisfranc injuries treated operatively with reduction and fixation. We performed a retrospective review of all Lisfranc injuries treated operatively in a single institution over a 6-year period. Injuries were classified as primarily ligamentous or combined by independent evaluation of available computed tomography (CT) or magnetic resonance imaging. Outcomes were measured using the Short Musculoskeletal Function Assessment (SMFA). CT of 29 patients was performed at last follow-up to evaluate reduction and degenerative changes. Of the 56 patients identified, 38 were available for follow-up. The average follow-up was 3.8 years. There were 26 combined injuries and 12 primarily ligamentous injuries. Outcomes were excellent in all patients and there was no statistical difference in SMFA scores in any category between the groups. On follow-up CT, all injuries were anatomically reduced, and 26 of 29 patients had degenerative changes. Our results support that reduction and stable fixation of Lisfranc injuries may be suitable treatment regardless of classification as combined or primarily ligamentous. Future larger-scale prospective studies should be pursued to supplement existing data.